Personal Medical History Form

Personal Medical History Form Section 1 is intended for use by everyone. It is important and a good idea to have this information available for when it is needed.

Copy and paste the Personal Medical History Form to a Word program. Then fill it out, print it and keep it in a secure place.

Personal Medical History Section 1

Personal Details

Name (prefix, first, last):

Date Of Birth (DOB):

Gender:

Ethnicity:

Marital Status:

Height:

Weight:

Contact Information

Next of Kin (NOK) or Friend:

Name:

Phone Number:

Address:

Medical Summary

1. Blood Type:

Blood transfusions can be the most critical part of a medical procedure. Blood transfusions play a lifesaving role in serious accidents of any type.

If you may ever need a blood transfusion, it is an essential requirement for the medical personnel treating you to know your blood type. If not available, you have to have stat tests which cause time delays and may take too long in order to save your life.

Blood transfusions help save nearly 10,000 lives each day. Therefore, if you don't know your blood type, get a blood test and identify your blood type at your earliest convenience. It is a quick and easy test.

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